Basic Information
| Provider Information | |||||||||
| NPI: | 1245315779 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | CARL | ||||||||
| MiddleName: | LESTER | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3224 LINDEN DR. | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9072430598 | ||||||||
| FaxNumber: | 9072430597 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 WEST DIMOND BLVD. | ||||||||
| Address2: | SUITE 12 | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073417757 | ||||||||
| FaxNumber: | 9073417760 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 08/01/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 0473 | AK | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AS0400X | 0473 | AK | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.